老年复杂核型急性淋巴细胞白血病病例学习

Case Study of Complex Karyotype Acute Lymphoblastic Leukemia in the Elderly

摘要: 急性淋巴细胞白血病(Acute Lymphoblastic Leukemia, ALL)是一种起源于淋巴细胞的B系或T系细胞在骨髓内异常增生的恶性肿瘤性疾病。其致癌蛋白BCR/ABL有两种亚型，BCR/ABLP210和BCR/ABLP190，前者是慢性髓系白血病的标志，而后者存在于大多数费城染色体阳性(Philadelphia chromosome+, ph+)的急性淋巴细胞白血病(Ph+-ALL)患者中。Ph+-ALL是成人常见类型，约占成人ALL的25%~30%，而ph染色体阳性且BCR/ABLP190阳性的染色体核型约占15%~18%，临床特点包括年龄偏大、肝脾肿大、淋巴结肿大、高白细胞等，常累及中枢神经系统，主要表现为贫血、感染、出血、异常器官组织浸润(引发头痛、关节痛、腹痛、胸骨后压痛等)等，临床上以贫血、出血、胸骨后疼痛为首发者多见，以腹痛为首发较少见，本文将我科收治的以腹痛为首发表现的Ph+急性白血病一例报道如下。

Abstract: Acute lymphoblastic leukemia is a malignant neoplastic disorder in which B- or T-lineage cells originating from lymphocytes are dysplastic within the bone marrow. There are two subtypes of carcinogenic protein BCR/ABL, BCR/ABL P210 and BCR/ABL P190; the former is a marker of chronic myeloid leukemia, while the latter is found in most Philadelphia chromosome positive acute lymphoblastic leukemia patients. Ph+-ALL is a common type in adults, accounting for about 25%~30% of ALL adults. However, the karyotype of ph chromosome positive and BCR/ABLP190 positive chromosome is rare, accounting for about 15%~18%. Clinical features include older age, hepatosplenomegaly, enlarged lymph nodes, high white blood cells and so on, involving central nervous system. The main manifestations are anemia, infection, bleeding, abnormal organ and tis-sue infiltration (causing headache, joint pain, abdominal pain, retrosternal tenderness, etc.). It is rare to start with abdominal pain. A case of Ph+ acute leukemia with abdominal pain as the first manifestation in our department is reported as follows.